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An Immuno-Fragile Profile Is Associated with Mortality Risk in Patients with Chronic Kidney Disease
Noemí Ceprián1,2, Irene Martínez de Toda1,2, Paula Jara Caro2,3
1Departamento de Genética, Fisiología y Microbiología, Facultad de Ciencias Biológicas, Universidad Complutense de Madrid, 28040 Madrid, Spain.
Biomedicines
|October 29, 2025
Summary
Chronic kidney disease (CKD) patients exhibit an "immuno-fragile profile" combining immune dysfunction and frailty. This profile significantly predicts mortality risk, especially in hemodialysis and end-stage renal disease patients.
Area of Science:
- Nephrology
- Immunology
- Gerontology
Background:
- Chronic kidney disease (CKD) patients have increased risks of infections, poor vaccine responses, and cardiovascular diseases.
- Immune dysfunction and frailty contribute to higher morbidity and mortality in CKD.
- Understanding the interplay between immune status and frailty is crucial for CKD patient outcomes.
Purpose of the Study:
- To evaluate immune status and frailty in CKD patients across different treatment modalities.
- To examine how frailty influences immune status in CKD.
- To determine the association between immune status, frailty, and mortality in CKD.
Main Methods:
- 174 participants included: end-stage renal disease (ESRD), hemodialysis (HD), peritoneal dialysis, kidney transplant patients, and healthy controls.
- Immunophenotyping of lymphocyte and monocyte subpopulations; frailty assessed using the Edmonton Frail Scale.
- Principal component analysis (PCA) integrated immune and frailty variables; survival monitored up to six years.
Main Results:
- CKD patients, particularly on HD, showed reduced lymphocyte counts and altered monocyte subpopulations with increased co-stimulatory molecule expression.
- Frailty was most prevalent in HD patients (53%), with significant sex differences.
- PCA identified lymphocyte counts, monocyte co-stimulatory expression, and frailty as key components predicting 70% of variance; lower lymphocytes and higher frailty correlated with increased mortality risk.
Conclusions:
- An integrated
- immuno-fragile profile
- combining immune alterations and frailty is strongly associated with mortality in CKD patients.
- This immuno-fragile profile can serve as a prognostic tool for risk stratification in CKD.
- Personalized interventions guided by this profile may improve clinical practice and patient outcomes.
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